[Silent myocardial ischemia].

As an introduction the main aspects concerning clinical picture, subgroups, pathophysiology, frequency, prevalence and incidence, diagnosis, prognosis and therapy of silent ischemia are summarized: 1) CLINICAL PICTURE: Transient silent ischemia (SMI), silent infarction, relationship to sudden cardiac death, ischemic "cardiomyopathy". 2) Subgroups of SMI: SMI patients (always symptomatic patients without myocardial infarction, after infarction, after stable or unstable angina pectoris, after coronary angioplasty, and after bypass surgery). SMI episodes in otherwise symptomatic patients with coronary heart disease (without myocardial infarction, after infarction, with stable or unstable angina, after coronary angioplasty and after bypass surgery). 3) PATHOPHYSIOLOGY: SMI patients: generally reduced sensitivity to pain. SMI episodes: differences in severity and duration of ischemia. 4) Frequency: Approximately one-third of all provoked ischemic episodes are silent (independent of the mode of provocation and the ischemia indicators used), two-thirds of all spontaneous ischemic episodes are silent. 5) Prevalence and incidence: 2-5% of all healthy males aged 40-59, and 20-30% of all postinfarction patients are SMI-patients; 60-90% of all symptomatic patients with coronary heart disease have additional SMI-episodes. 6) DIAGNOSIS: screening by means of exercise ECG in patients at high risk for coronary heart disease, and in patients working in specific professions (like busdrivers, pilots, etc.). Systematic screening in postinfarction patients, in patients after unstable angina, after coronary angioplasty or bypass surgery.(ABSTRACT TRUNCATED AT 250 WORDS)